A Sales Rep's View of OR Bullying
Re: "Staring Down OR Bullies" (September, page 38). Bullying is serious, and it's not funny, but I can't help laughing a little while reading your excellent article. As sales reps in the OR, we bear witness to this on occasion, mostly surgeon-to-nurse bullying, as you mentioned. You described a "hierarchy" of male surgeons at the top and female nurses at the bottom. What you left out is that somewhere below the bottom of this hierarchy is the sales rep, male or female. We often feel the repercussions of the frustrated nurse, who was just unfairly blistered by the surgeon. We all know what rolls downhill, and sometimes it's the sales rep, not the nurse at the very bottom. Still, 99 percent of our interactions with OR staff are very pleasant, and their patient care advocacy is critical to the adoption of our product and therapy. Since we rarely see our co-workers at our own company, and although we are visitors in the OR, we consider the OR nurses in our territories our co-workers and in many cases our friends.

Joe Terry
Lone Star Region Vice President
I-Flow Corporation
[email protected]

CRNAs Stand Up (and Bill) for Themselves
Re: "Do CRNAs Really Cost Less?" (June, page 8). Creating a wall between CRNAs and anesthesiologists is never a good thing, but letters like this do that very thing. There's absolutely no outcomes-based evidence that GI procedures "should be done only under the supervision of an anesthesiologist." Many sites around the country use CRNAs as their sole providers. These hard-working folks bill for themselves and don't charge overtime or ask for the cost of malpractice insurance or retirement. As a group, CRNAs offer quality care for patients around the world, from the military to the outback.

Norma Sorelle, CRNA, APRN
President
Massachusetts Association of Nurse Anesthetists
[email protected]

I am the CRNA-owner of an anesthesia group. I work with a surgery center and I bill independently, just as CRNAs in many states do. Because I bill for my group, we're available to work at the center whenever they need us. We also frequently accompany the gastroenterologist to the hospital to perform anesthesia for emergent cases. If the center wanted to, it could employ CRNAs and bill for their services. The nurse anesthetists would earn enough to pay for their salary and benefits and would also still generate a profit for the center. It's a no-brainer: CRNAs cost less or nothing depending on your employment situation.

Kelly DeFeo, CRNA, APRN, PhD
Dynamic Anesthesia, PLLC
Center Conway, N.H.
[email protected]

Dealing With Disruptive Surgeons
Re: "C'mon, Surgeons Can't Be This Bad" (August, page 8). Trying to diminish inappropriate physician behavior and keep your numbers up is a vicious cycle. A disruptive physician coached our nurses to write and sign a letter to administration saying he "just has a sense of humor" or he might have to take his cases elsewhere. I can only hope the new Joint Commission standards carry some weight. We have staff who will beg to not work with disruptive surgeons, but this isn't always possible.

Name withheld upon request

For the Record
We misidentified Stryker's new 1188 High Definition Autoclavable 3-Chip Camera in "Thinking of Buying...An Endoscopic Camera" (September, page 88) by omitting the word "autoclavable" from its name. In comparison, Stryker's previous model, the 1188 High Definition 3-Chip Camera, is not autoclavable.

The correct diagnosis for plica resection is 727.83 (Plica syndrome). "When to Report Synovectomy Separately" (September, page 26) listed the incorrect CPT code.

In Support of Laparoscopic Colectomy
Re: "Is Laparoscopic Colorectal Surgery Staging a Comeback?" (August, page 72). This article confirmed that, after years of being a surgical option, laparoscopic colorectal surgery is gaining momentum and becoming more accessible for patients.

In further support of the laparoscopic approach, a recent study I co-authored, "Clinical Outcomes and Resource Utilization Associated With Laparoscopic and Open Colectomy Using a Large National Database," published in the May issue of Annals of Surgery, examined more than 32,000 elective colectomy patients in 402 hospitals across the country. Across almost all patient care criteria and economic implications, we found laparoscopic colectomy was superior to an open approach.

In addition to a reduction of in-hospital complications, including infections, patients who underwent laparoscopic colectomy had a shorter length of stay, lower mortality and a significant reduction in post-discharge nursing care. Considering the broad base of patients from the wide variety of institutions examined in this study, this research helps to address any remaining questions about the efficacy and value of a laparoscopic approach.

Although the adoption rate for laparoscopic colectomy has been slower than other laparoscopic procedures, more surgeons are being trained to perform these procedures, which will hopefully improve patient care and reduce costs.

Conor P. Delaney, MD, MCh, PhD
Professor of Surgery
Chief of Colorectal Surgery
Vice-Chair, Department of Surgery
University Hospitals/Case Western Reserve University
[email protected]